Ct Application Permit Work Details

The Connecticut Form A 62 is a form that must be filed with the Department of Revenue Services by any person who has participated in an out-of-state transaction. The form is required for any type of income, including but not limited to wages, salary, pensions, retirement benefits and Social Security benefits. The Connecticut Form A 62 contains information about the individual's employer or payer, as well as their address outside of Connecticut. They will also complete line 7 on this page which asks if they are subject to withholding of tax by another jurisdiction on all or some types of income from sources within that other jurisdiction. If so, they will need to provide their name and taxpayer ID number where tax is withheld.

Below are some specifics of connecticut form a 62. You will have the projected time you will need to complete the form and a few additional details.

QuestionAnswer
Form NameConnecticut Form A 62
Form Length1 pages
Fillable?Yes
Fillable fields38
Avg. time to fill out7 min 55 sec
Other namesct blasting permit form, ct vehicle work, connecticut permit work, special permit motor

Form Preview Example

STATE OF CONNECTICUT
DEPARTMENT OF MOTOR VEHICLES
DRIVER SERVICES DIVISION
60 STATE STREET, WETHERSFIELD, CT 06161-2530
TELEPHONE: (860) 263-5720 On The Web At ct.gov/dmv

APPLICATION FOR SPECIAL PERMIT TO

OPERATE A MOTOR VEHICLE TO AND FROM WORK

A-62 REV. 4-2010

INSTRUCTIONS:

1. Please print or type.

2. Multiple employment requires separate applications.

3. A $100.00 non-refundable application fee in the form of a check or money order payable to DMV must accompany each request for a permit.

Operation of motor vehicles requiring a CDL or used for Public Passenger Transportation is PROHIBITED under the Special Permit Program

YOUR OFFICIAL DRIVING RECORD WILL BE REVIEWED AS PART OF THIS APPLICATION.

NAME OF APPLICANT (Last, First, Middle)

DATE OF BIRTH

OPERATOR LICENSE NUMBER/STATE

SEX

M

F

MAILING ADDRESS

(Number and Street)

(City or Town)

(State)

(Zip Code)

 

 

 

 

 

RESIDENCE ADDRESS (If different)

(Number and Street)

(City or Town)

(State)

(Zip Code)

NAME OF EMPLOYER (If self-employed, include business name and legal proof of self-employment)

ADDRESS OF EMPLOYER

(Number and Street)

(City or Town)

(State)

(Zip Code)

OCCUPATION

HOME TELEPHONE NUMBER

( )

DAYS AND HOURS OF EMPLOYMENT (Specify A.M. or P.M.)

TO BE ISSUED A WORK PERMIT, YOUR SCHEDULE MUST BE CLEARLY IDENTIFIED, AND

MON.

TUE.

THU.

FRI.

SAT.

MAY NOT EXCEED A CONTINUOUS 12-HOUR PERIOD PER DAY.

IF YOU HAVE MORE THAN ONE PLACE OF EMPLOYMENT, EACH EMPLOYER MUST

WED.SUN.

COMPLETE A SEPARATE APPLICATION.

What is the distance and the commuting time from your residence to your place of employment?

Is public transportation available

 

 

 

from your residence to your

YES

NO

 

place of employment?

 

 

 

What significant hardship(s) will you suffer without a Special Operator's Permit?

 

 

What efforts have you made to obtain other transportation?

INABILITY TO CONFIRM YOUR EMPLOYMENT MAY RESULT IN DENIAL OF YOUR SPECIAL OPERATOR'S PERMIT.

PRINTED NAME OF SUPERVISOR

SIGNATURE OF SUPERVISOR

X

PRINTED JOB TITLE OF SUPERVISOR

WORK TELEPHONE

()

NOTICE:

OATH:

Your operator's license is under suspension. If you operate any vehicle outside of the authorized hours, you may be subject to arrest. If you operate a motor vehicle for a purpose not authorized by law, a police officer may make a report to the Commissioner of Motor Vehicles and you will be subject to a civil penalty of up to $500. If your operator's license is suspended for another reason while you are in possession of this permit, the permit is revoked, and if you thereafter operate a motor vehicle you will be subject to double the penalties imposed by law. If you alter or make improper use of the permit, you will be subject to criminal penalties.

I swear or affirm under penalty of false statement in accordance with Connecticut General Statute 53a-157, and subject to penalties for perjury for a deliberate false statement, that the above information and any attachment hereto is true and correct.

PRINTED NAME OF APPLICANT

SIGNATURE OF APPLICANT

DATE SIGNED

X

DMV USE ONLY

PERMIT:

APPROVED

DENIED

DATE PERMIT ISSUED

(If Approved)

PERMIT VALID UNTIL (If Approved)

REASON FOR DENIAL

DRIVING HISTORY

NO SIGNIFICANT HARDSHIP

INELIGIBLE

OTHER (Provide Details)

AUTHORIZED SIGNATURE (DMV)

X

PRINTED NAME

DATE SIGNED

How to Edit Connecticut Form A 62

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Step 1: Choose the button "Get Form Here" and then click it.

Step 2: Now you are ready to edit ct special permit. You've got many options thanks to our multifunctional toolbar - it's possible to add, delete, or change the information, highlight the particular areas, as well as undertake many other commands.

Provide the content demanded by the platform to create the document.

application special permit gaps to fill out

Inside the section WED, SAT, SUN, ISSUED A WORK PERMIT, EACH, What is the distance and the, Is public transportation available, YES, What significant hardship(s) will, What efforts have you made to, INABILITY TO CONFIRM YOUR, PRINTED NAME OF SUPERVISOR, SIGNATURE OF SUPERVISOR, PRINTED JOB TITLE OF SUPERVISOR, and WORK TELEPHONE ( ) write down the particulars the program asks you to do.

application special permit WED, SAT, SUN, ISSUED A WORK PERMIT, EACH, What is the distance and the, Is public transportation available, YES, What significant hardship(s) will, What efforts have you made to, INABILITY TO CONFIRM YOUR, PRINTED NAME OF SUPERVISOR, SIGNATURE OF SUPERVISOR, PRINTED JOB TITLE OF SUPERVISOR, and WORK TELEPHONE ( ) blanks to fill out

You can be asked to provide the information to help the program fill in the section WORK TELEPHONE ( ), NOTICE:, Your operator's license is under, OATH:, I swear or affirm under penalty of, PRINTED NAME OF APPLICANT, SIGNATURE OF APPLICANT, DATE SIGNED, PERMIT:, REASON FOR DENIAL, APPROVED, DENIED, DMV USE ONLY, DATE PERMIT ISSUED, (If Approved), PERMIT VALID UNTIL, (If Approved), DRIVING HISTORY, NO SIGNIFICANT HARDSHIP, INELIGIBLE, and OTHER (Provide Details).

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